Journal of Management & Governance

, Volume 17, Issue 1, pp 59-69

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Assessing the effectiveness of a performance evaluation system in the public health care sector: some novel evidence from the Tuscany region experience

  • Sabina NutiAffiliated withInstitute of Management, Laboratorio Management e Sanità, Scuola Superiore Sant’Anna
  • , Chiara SeghieriAffiliated withInstitute of Management, Laboratorio Management e Sanità, Scuola Superiore Sant’Anna
  • , Milena VainieriAffiliated withInstitute of Management, Laboratorio Management e Sanità, Scuola Superiore Sant’Anna Email author 


Since 80’s the introduction of New Public Management principles has promoted the use of performance measurement to drive a more efficient, effective and accountable public sector. The adoption of a sophisticated and comprehensive multidimensional performance measurement system, which looks beyond traditional financial measures, based on organization strategies, such as the balanced scorecard, has thus been suggested. This revolution in the public management came together with the devolution processes that involved most European public health systems. Set within this context, in the last decade, each of the twenty Italian regions developed its own management tools. Among others, the Tuscan performance evaluation system (PES) has been valued as a particularly innovative and comprehensive system. This paper reports the novel experience of the Tuscan PES; in particular, it measures PES effectiveness and discusses the critical factors that could have led to the PES success. Five are the critical success factors identified by researchers: the visual reporting system, the linkage between PES and CEO’s reward system, the public disclosure of data, the high level of employees and managers involvement into the entire process and the strong political commitment. All those factors run together to achieve better results; however, the process of development of the system plays a pivotal role. Scholars suggest the use of a constructive approach in order to gain effective changes in human organization. According to this stream of literature, this paper contributes by the novel experience of the Tuscan PES in addressing as a further fruitful application of the constructivist approach in healthcare.


Multidimensional performance evaluation system Benchmarking Governance Constructivist approach